Louisiana is giving its nursing home more Medicaid funding than it was 10 years ago, even though the number of patients had stayed the same. (
The amount of Medicaid funding Louisiana is doling out to nursing homes increased by 54 percent from $112 million in 2006 to $173 million in 2016, even though the number of Medicaid patients staying in those nursing homes remained virtually the same, according a report from the Louisiana Legislative Auditor released Monday (Nov. 20).
Yet in spite of getting considerably more money to treat the same number of patients, nursing homes in Louisiana continue to rank poorly in terms of care when compared to others nationally. In 2007, AARP ranked Louisiana 49th for nursing home residents with pressure sores, 50th for the percent of residents who are hospitalized, and 51st for residents who are receiving antipsychotic medications, according to the audit report.
The auditor made a number of suggestions about how the Louisiana Department of Health could save on Medicaid payments made to nursing homes, some of which the agency agreed to implement.
The audit is just the latest example of the political power the nursing homes have in Louisiana. The industry has a close relationship Gov. John Bel Edwards and several legislators, some of whom are part owners of nursing home facilities. Evidence mounts that increasing home health care options for Medicaid patients would be more efficient — and in many cases the preferred option for those being treated — but efforts to move away from a dependency on nursing homes have been stymied at the Louisiana statehouse.
Legislators — with voters’ approval — have inserted protections for the nursing home industry into the state constitution, which makes it more difficult to cut its funding or divert it to cheaper home health care options that Medicaid patients often prefer. Much of the auditor’s report covers a period of time when Gov. Bobby Jindal was in office. Jindal, like Edwards, often sided with the nursing home industry, a major political donor, and blocked efforts to divert Medicaid funding away from nursing homes.
In the report released Monday, the auditor discovered that some ways in which Louisiana calculates in Medicaid payments to nursing homes are out-of-step with practices in other states and result in Louisiana paying more. If Louisiana brought their practices more in line with other states, it could have saved the state $77 million in 2016, according to the report. To do so though would require a change in more than one state law.
Louisiana could also save money by conducting more thorough audits of nursing homes annually and needs to collect more fines and penalties from nursing homes when they are found to not be compliant. The Louisiana Department of Health also isn’t properly monitoring whether nursing home patients are eligible for Medicaid. In 2014, the auditor found that Louisiana had made $3.2 million worth of improper Medicaid payments because it was paying for people who shouldn’t have been eligible for the assistance.
The Louisiana Department of Health said it didn’t catch these improper payments because it is the responsibility of the patient to inform the facility that he or she has more resources than Medicaid allows. The agency has since told the auditor that it will "restructure" in order to hold facilities, as opposed to patients, responsible for reporting this information. In a letter to the auditor, the health agency said it had already made some adjustments to address the problem.
The auditor also said the Louisiana Department of Health should adjust payments to nursing homes downward more when it finds errors in patients’ files. Had it made more adjustments due to file errors in the 2016 budget cycle, it could have saved $532,500. The Louisiana Department of Health also doesn’t have an internal program to identify improper payments to nursing homes, though it contracts with an outside company to sometimes do so.
The auditor also complained that Louisiana isn’t ensuring that nursing homes are spending as much of the Medicaid funding that they receive directly on patient care as required by the federal government.
The Louisiana Department of Health has said it will make changes to address the auditor’s concerns where possible, but a number of these problems were previously identified by the legislative auditor in a 2005 report, when Gov. Kathleen Blanco was in office. At the time, the Louisiana Department of Health agreed to make adjustments to address the problems, but then never actually implemented the changes proposed, according to the auditor.
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Julia O’Donoghue is a state politics reporter based in Baton Rouge. She can be reached at email@example.com or on Twitter at @jsodonoghue. Please consider following us on Facebook at NOLA.com.
LaToya Cantrell celebrates her victory in the New Orleans mayoral election during her election party at the New Orleans Jazz Market in Central City on Saturday, November 18, 2017.
In this July 7, 2017, file photo, LaVar Ball, father of Los Angeles Lakers’ Lonzo Ball and UCLA player LiAngelo Ball, watches the Lakers play the Los Angeles Clippers during an NBA summer league basketball game, in Las Vegas. President Donald Trump tweeted Sunday, Nov. 19, that he should have left three UCLA basketball players, including LiAngelo Ball, accused of shoplifting in China in jail after LaVar Ball minimized Trump’s involvement in winning the players’ release during an interview Saturday, Nov. 18, with ESPN. (AP Photo/John Locher, File)
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